Selective hanging maneuver and rubber band retraction technique for pure laparoscopic donor right hepatectomy.

BACKGROUND: Pure laparoscopic donor hepatectomy (PLDH) is an increasingly performed procedure despite its technical difficulties. This study introduced a selective liver parenchymal hanging maneuver and rubber band retraction technique for PLDH. METHODS: We retrospectively reviewed perioperative data from 58 patients who underwent donor right hepatectomy (including right extended) between March 2009 and February 2021. Eighteen patients underwent open donor right hepatectomy (ODRH) and 38 patients underwent pure laparoscopic donor right hepatectomy (PLDRH). RESULTS: All PLDRH donors underwent the procedure without the need for open conversion. The median PLDRH operative time was 396.84 ± 72.459 min, the median PLDRH intraoperative bleeding amount was 496.05 ± 272.591 ml, and the warm ischemic time was 8.77 ± 3.062 min. Compared to ODRH, laparoscopic surgery showed further advantages in terms of postoperative hospital stay (10.94 ± 4.036 days vs. 8.03 ± 2.646 days, respectively, P = 0.01) and estimated blood loss (676.67 ± 321.046 ml vs. 496.05 ± 272.591 ml, respectively, P = 0.033). CONCLUSIONS: The selective liver parenchymal hanging maneuver and rubber band retraction technique is a simple and effective pure laparoscopic procedure for donor hepatectomy. Our results demonstrate the safety and feasibility of this technique.

Clinical Pattern of Preoperative Positron Emission Tomography/Computed Tomography (PET/CT) Can Predict the Aggressive Behavior of Resected Solid Pseudopapillary Neoplasm of the Pancreas.

Predicting the aggressiveness of solid pseudopapillary neoplasms (SPNs) remains an important goal. The present study aimed to identify perioperative factors that can predict patients who will develop clinically aggressive SPN. Records of individuals with pathologically confirmed SPN from 2006 to 2017 were obtained from the patient registry database of Yonsei University, Severance Hospital. For this study, aggressive behavior was defined as SPN that had recurred, metastasized, or involved adjacent organs. A total of 98 patients diagnosed with SPNs were analyzed retrospectively. Of these, 10 were reported to have SPNs with aggressive characteristics. We found that age (≥40 years; p = 0.039), symptomatic presentation (p = 0.001), tumor size (>10 cm; p < 0.001), positron emission tomography/computed tomography (PET/CT) classification (p < 0.001), and lymphovascular invasion (p = 0.003) were significantly correlated with aggressive behavior of SPNs. Multivariate analysis showed that PET/CT configuration (p = 0.002) (exp(ß)111.353 (95% confidence interval (CI): 5.960-2081), age ≥40 years (p = 0.015) (exp(ß) 23.242 (95% CI: 1.854-291.4)), and lymphovascular invasion (p = 0.021) (exp(ß) 22.511 (95% CI: 1.595-317.6)) were the only independent factors associated with aggressive SPN. Our data suggest that age ≥40 years, PET/CT Type III configuration, and lymphovascular invasion are independent factors associated with aggressive SPN. This information can help clinicians develop individualized management and surveillance plans to manage patients more effectively.

Aggressiveness of solid pseudopapillary neoplasm of the pancreas: A literature review and meta-analysis.

BACKGROUND: Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare tumors considered to be benign although 10% to 15% of SPNs have been reported to be aggressive. Due to its rarity, there have only been a few cases reported regarding the clinical course of patients with aggressive SPNs. The goal of this study is to describe the clinical course of patients diagnosed with aggressive SPNs. METHODS: A PubMed search was done looking for articles describing the clinical course of patients diagnosed with SPN that locally invaded, recurred, or metastasized. Institutional experience was also added to the pooled data. Patient information was extracted from the articles. Survival and recurrence curves were plotted and factors associated with survival and recurrences were analyzed. RESULTS: A total of 59 patients were identified to have aggressive SPN. Seven patients were males and 52 were females and the mean age was 37.44 ±â€Š2.21 years. Systemic metastasis constituted 81.4% while recurrence and deep tissue invasion were found in 11.9% and 6.8% of the patients, respectively. Disease-free survival was 45 ±â€Š6.28 months and disease-specific survival was 152.67 ±â€Š12.8 months. In survival analysis, age, gender, tumor size, tumor location, combined resection, type of recurrence, and stage IV on diagnosis were not significant factors in predicting survival. However, an unresectable tumor (hazards ratio [HR] = 4.871, 95% confidence interval [CI] 1.480-16.03, P = .009), and metastasis within 36 months (HR = 6.399, 95% CI: 1.390-29.452, P = .017) were identified as independent variables in predicting survival. CONCLUSION: SPNs of the pancreas carry a favorable course. Despite having aggressive properties, patients can still survive for more than 10 years as long as the tumor can be resected completely.

Indocyanine Green Perfusion Imaging-Guided Laparoscopic Pancreaticoduodenectomy: Potential Application in Retroperitoneal Margin Dissection.

BACKGROUND: During laparoscopic pancreaticoduodenectomy (LPD), dissecting uncinate process from the superior mesenteric artery (SMA) will determine one of the important surgical margins (retroperitoneal margin) for predicting oncological outcomes and the quality of LPD. However, clear identification of the division line for retroperitoneal margin is not easy as the uncinate process of the pancreas is anatomically very close to SMA and intermingled with the nerve plexus and soft tissues around SMA. In this study, we present data regarding the potential usefulness of indocyanine green (ICG)-enhanced approach in obtaining retroperitoneal margin during LPD. METHODS: From January to September 2017, medical records of patients who underwent LPD for periampullary pathological conditions were retrospectively reviewed. ICG (5 mg/2 cm3) was prepared and intravenously injected when dissecting uncinate process of the pancreas. Perioperative outcomes, including gender, age, diagnosis, body mass index, operation time, estimated blood loss, transfusion, presence of postoperative pancreatic fistulas (POPFs), and length of hospital stay, were evaluated. RESULTS: During the study period, a total of 37 patients underwent LPD for periampullary pathological lesions. Among them, ICG-enhanced dissection of uncinate process of the pancreas was applied in 10 patients (27%). All patients were able to obtain margin-negative resection. There were no significant differences between the perioperative outcomes of patients who did and did not undergo ICG-enhanced approach. DISCUSSION: ICG perfusion-based laparoscopic dissection of retroperitoneal margin is feasible and safe in LPD. This intraoperative visual difference can provide the surgeon with very helpful real-time visual information. Further study is mandatory.

Experiences in central pancreatectomy.

BACKGROUND: Non-cancerous pancreatic lesions have been increasing, and function-preserving pancreatectomy may be an adequate approach to them. Recent advanced experience of major pancreatectomy has stimulated interest in central pancreatectomy (CP). MATERIALS AND METHODS: Nineteen patients who underwent CP for benign and borderline malignant lesions of the pancreas from January 1990 to December 2007 were retrospectively reviewed. We also summarized recent literature reporting more than 10 cases of CP. RESULT: Nine patients (47.4%) experienced postoperative complications. Pancreatic leak was noted in 7 patients (36.8%). Two patients (10.5%) required reoperation due to intractable pancreatic leak and postoperative bleeding. No mortality was noted. During the follow-up period (median 35 months, range 3-182 months), only 1 patient (5.3%) developed new-onset diabetes after successful CP. In a comparative study, similar perioperative morbidity was noted between CP and extended distal pancreatectomy with splenectomy (extended DP-S); however, the operation time and postoperative hospital stay were significantly longer in the CP group and the incidence of new-onset diabetes was much lower in the CP group as compared with the DP-S group (p < 0.05). CONCLUSION: CP can be carefully selected as an appropriate surgical option for benign and borderline malignant lesions limited to the pancreatic neck area.

The prognosis and survival analysis according to seven staging systems of hepatocellular carcinoma following curative resection.

BACKGROUND/AIMS: Several staging systems have been introduced to predict the prognosis of hepatocellular carcinoma (HCC). The aim of current study was to analyze the clinicopathologic prognostic variables and calculate overall survival and disease-free survival rates to compare the prognosis of HCC patients treated with curative resection according to seven different staging systems. METHODOLOGY: A retrospective study of 163 patients with HCC who underwent curative resection in our department between January 1998 and December 2001 was conducted. The clinicopathological prognostic factors were identified by univariate analysis. The patients were classified according to the TNM (AJCC 5th and 6th edition), Okuda, BCLC (Barcelona Clinic Liver Cancer), JIS (Japanese Integrated System), CLIP (Cancer of Liver Italian Program), and GRETCH (Group d'Etude de Traitement du Carcinoma Hepatocellullarire) systems. The overall survival and disease free survival were calculated using the Kaplan-Meier method. RESULTS: Univariate analysis of clinicopathologic prognostic factors indicated that tumor size, satellite nodules, portal vein invasion, bile duct invasion, microvessel invasion, differentiation and albumin level were statistically significant factors for survival. Mean survival time was 72.3+/-3.0 months. The overall survival curve and the disease-free survival curve applied to TNM (AJCC 6th edition) staging clearly show the difference in survival. CONCLUSIONS: The TNM (AJCC 6th edition) staging system provides the most effective means of assessing the prognosis of patients following curative resection of HCC.

Inflammatory pseudotumor of the liver treated by hepatic resection: a case report.

Inflammatory pseudotumor (IPT) of the liver is rare benign tumor. When the diagnosis of IPT is established with biopsy, simple observation or conservative therapy is preferred because of the possibility of regression. But IPT is unresponsive to the conservative treatment, surgical resection should be considered. We experienced a 63-year-old male, who was suspected hepatocellular carcinoma in abdominal computed tomography (CT) and magnetic resonance image (MRI) scan, presented with 2-month history of intermittent fever and weight loss. Percutaneous ultrasound guided core biopsy confirmed IPT of the liver. Non-steroidal anti-inflammatory drugs and antibiotics were administered for 8 and 4 weeks, respectively, but fever continued. So, extended right hepatectomy was performed for IPT of the liver and then fever subsided. The patient remains well during a follow-up period of 12 months.